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Supplemental Data Form

This form is used to supplement the information provided on the Free Application for Federal Student Aid (FAFSA).

The 2019-2020 Supplemental Data Form can be submitted on-line via the form below.

If you would prefer a PDF version to fill out by hand, please click here for the 2019-2020 Supplemental Data Form or here for the 2018-2019 Supplemental Data Form.

2019-2020 Supplemental data form

Section A: General Information

Must be completed by ALL applicants

Student Identification

Title:

Mr.

Ms.

Mrs.

First name:

Middle name:

Last name:

Permanent address:

City:

State:

Zip/PC:

Telephone:

Email:

Birthdate (mm/dd/yyyy):

Age:

Dependents:

Year in College in 2019-20:

1

2

3

4

5

US citizen?

Yes

No

If not, are you a permanent resident?

Yes

No

Dual citizen?

Yes

No

If yes, what countries?

State of legal residence:

Do you have transportation?

Yes

No

If yes, what is its make and year?

Have you ever attended another college?

Yes

No

If yes, please list name, city, state, and dates attended:

Church name and denomination:

High school attended:

List 2018 employment-- employer and description of position:

Have you applied or will you apply to any other college for 2019-20?

Yes

No

If yes, other college(s) applied to:

Will you be a commuter?

Yes

No

Financial Aid Information

Do you intend to be a full-time student?

Yes

No

Have you completed the Free Application for Federal Student Aid (FAFSA) or the online Renewal Application?

Yes

No

If yes, when did you submit it?

List any outside scholarships, grants, bursaries, loans or other assistance (including dollar amounts) that you expect to receive for the 2019-20 school year. It is not necessary to list any aid from Dordt College; only outside sources:

Did you have a job on campus last year?

Yes

No

If yes, please list:

Section B: Parents' Information

For all DEPENDENT students

Father/Stepfather:

Father/Stepfather Occupation:

Father/Stepfather Employer:

Mother/Stepmother:

Mother/Stepmother Occupation:

Mother/Stepmother Employer:

Did either parent attend Dordt for one full year or more and successfully complete at least 24 credits?

Yes

No

If yes, who?

FAFSA Information

Give information for all dependent children and other dependents for 2018-19 (those included in the FAFSA).

Please list the 1) name and relationship (e.g. brother, sister), 2) age, 3) Name of school or college this person will attend in 2019-20 school year, 4) Year in school 2019-20, and, if attended college in 2018-19, give amount of 5) 2018-19 scholarships or grants, and 6) 2018-19 parents' contribution for each dependent

*If more than 6 dependents, list additional family members under Other Special Circumstances.

Will either parent be attending college at least half-time in 2019-20?

Yes

No

If yes, please list name, city, and state of college:

Divorced/Separated Parents:

Completed by the parent who files this form.

Is there an agreement specifying a contribution for the student's education?

Yes

No

If yes, how much per year?

Parents' Assets:

Do parents own a home?

Yes

No

Value of home today:

Debt on home today:

Do parents own a farm?

Include a family farm which is your principal place of residence and source of revenue. Such farms are NOT to be reported on the FAFSA.

Value of farm today:

Debt on farm today:

Do parents own a small business?

Include a small family business which you own and control and that has 100 or fewer employees. Such businesses are NOT to be reported on the FAFSA.

Yes

No

Value of business today:

Debt on business today:

Parents' 2019 Expected Income:

2019 income earned from work by father:

2019 income earned from work by mother:

Section C: Request for Consideration of Special Circumstances

When this form is processed, formulas will be applied which assess how much the parents can contribute and how much the student can contribute. This effective family contribution will be based on parents' and student's income and assets with standard allowances made for other necessary expenses. Sometimes families have special circumstances which substantially affect their ability to contribute towards educational expenses. Two of the most common special circumstances at Dordt College are tuition paid for other family members at elementary or high schools, and excessive medical/dental expenses. Occasionally other factors may affect the family's contribution, such as: a significant reduction in parental income for the upcoming year, other non-discretionary expenses not mentioned on the form, a higher cost of living than the national average, a significant debt not reported on the form, or a natural disaster. (Special circumstances refer to something unique to your family.) If you would like to request consideration for special circumstances, please complete the appropriate items below.

Tuition for other children. Indicate the total tuition paid in 2018-19 for children in kindergarten through grade 12:

Medical/dental expenses not covered by insurance. An allowance will be considered for medical/dental expenses paid in 2018 if, including insurance premiums, they exceed 7.5% of income (Form 1040, Schedule A, line 1):

Other Special Circumstances--please itemize giving specific dollar amounts and explain in paragraph form any unusual situations:

By completing the box/boxes below and submitting this form I/we certify that all information is correct and complete: